Heroin use made more deadly with fentanyl

Booster drug makes heroin easier to supply, more fatal to use

Will County Coroner Patrick O'Neil is seen Wednesday in Joliet. O'Neil recently decided to supply his morgue with an opiate antidote to protect workers from accidental overdoses.

Note to readers: This is the first installment of a four-day series examining the cause of Will County’s record number of heroin-related deaths in 2016 and efforts to quell the epidemic.

The heroin death toll is getting worse because of the man-made additive fentanyl.

It’s a drug so powerful that Will County Coroner Patrick O’Neil recently decided to supply his morgue with an opiate antidote to protect workers from accidental overdoses.

“We’re getting Narcan for our morgue just in case our people come in contact with any of this,” O’Neil said.

Fentanyl is an opioid painkiller contributing to what anti-heroin advocates consider an epidemic that is killing Americans.

With nine heroin or opioid-related deaths in the month of January, Will County is on pace to see 108 people die from heroin-related overdoses this year, O’Neil said.

In 2016, there were 77 heroin-related deaths in the county. Of those, 32 involved some mixture of fentanyl.

More and more, overdose cases are showing a fentanyl mix was used. And, O’Neil said, the victim probably never knew what he or she was getting.

“You’d be unsuspecting,” O’Neil said. “There’s no patent on what someone’s getting from the drug dealer. They could be wanting cocaine and getting fentanyl. They could be wanting heroin and getting fentanyl.”

Pain and addiction

Fentanyl is a synthetic opioid used as a prescription drug to manage severe pain after surgery, according to the National Institute of Drug Abuse. Street names for fentanyl or fentanyl-laced heroin include Murder 8, Friend and China Girl.

Prescription fentanyl often is used for cancer patients to relieve pain.

It typically is used as a patch that’s applied to the skin for gradual release.

A heroin addict might smoke it, snort it or inject it.

“They’re only increasing the chances of a fatality when this stuff is mixed in,” O’Neil said.

A 20-year-old recovering heroin addict who spoke with The Herald-News said she did not really care about the risks involved when she began buying fentanyl patches from a friend in the neighborhood.

“I never really thought about it,” said the woman, who is in the recovery program at Stepping Stones in Joliet and did not want her name used. “I was already doing heroin. All bets were off.”

But she also said most heroin users don’t know exactly what they’re getting anymore.

“A lot of us don’t know that it’s fentanyl in there, and that’s why it’s killing us,” she said.

Lethal mixture

Fentanyl is being mixed into heroin basically as a cheaper additive – not unlike the general idea of using cane sugar substitutes in candy or soda. Except the process is completely uncontrolled, and the potency of fentanyl can be deadly.

“This stuff is killing people in numbers that are unbelievable,” said Tim Ryan, a heroin addict in recovery who has stayed off drugs since he was sentenced to prison on a drug charge in 2012.

Ryan is the founder of the Man in Recovery Foundation, which helps people fight drug addictions, and said he deals with fentanyl cases on a near-daily basis. Fentanyl use has been around for years, but it has grown significantly in the last two years, he said.

“The problem is now a lot of people think they’re using heroin. It’s not,” he said. “It’s fentanyl.”

Typical doses of Narcan, the overdose antidote used for heroin addicts, aren’t enough for a fentanyl overdose. That means families of opiate addicts who keep Narcan in the house may not be prepared for a fentanyl overdose.

“You can use five to six doses of Narcan. People don’t have that,” Ryan said. “It’s decimating people.”

The availability of heroin and the potential impact of fentanyl is a bigger problem than most people realize, he said.

“What people don’t understand is that it’s easier for a kid to get heroin than a six-pack of beer,” he said.

Ryan said he has worked with heroin addicts as young as 12. The oldest was 78. Typically, they come from a middle-class background. Most start out getting addicted to painkillers.

The “nasty part,” Roberts said, is the syringe and needles typically associated with heroin use. Purer forms of the drug make it possible to snort and smoke it.

Heroin is becoming more efficient and less expensive to use. Fentanyl is making it more efficient and less expensive to make.

“It increases the return on the product by increasing the potency,” Roberts said. “That’s what’s killing people, is you’re using a really strong dosage that just wasn’t mixed properly.”

Authorities in the Cleveland and Louisville areas have been looking into the impact of fentanyl on recent rashes of overdoses. Roberts believes such spikes typically are associated with badly mixed combinations of fentanyl and heroin.

“A pharmaceutical company goes to great lengths. They have to because of liability,” Roberts said. “Pushers don’t have to worry about product liability.”

One answer, he said, may be to increase the criminal liability that pushers face if someone dies from a heroin overdose.

Another may be to get a better handle on fentanyl production, much of which is believed to originate in China.

The Chinese government this month stated it intends to crack down on illegitimate fentanyl production.

U.S. Rep, Bill Foster, D-Naperville, said the Chinese are becoming increasingly aware of the problem. But fentanyl is produced in the United States, too, he said.

Foster, who has made opioid abuse prevention one of his top priorities, said growing awareness among doctors, who prescribe painkillers, also will help. He said doctors increasingly are being instructed to advise patients of the potential impact of the painkillers they prescribe.

“There’s this ladder of misery in the potency of opioids coming at us,” Foster said. “If you consider morphine as a one, heroin is 10 times more potent than morphine, and fentanyl is 100 times more potent.”